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Wu G, Wang C, Wang Y. Clinical application of JAK inhibitors in SAPHO syndrome. Int J Rheum Dis 2024; 27:e15231. [PMID: 39082278 DOI: 10.1111/1756-185x.15231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/01/2024] [Accepted: 06/06/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Guiying Wu
- Department of Rheumatology and Immunology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Inner Mongolia Key Laboratory for Pathogenesis and Diagnosis of Rheumatic and Autoimmune Diseases, Hohhot, China
| | - Cheng Wang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Inner Mongolia Key Laboratory for Pathogenesis and Diagnosis of Rheumatic and Autoimmune Diseases, Hohhot, China
| | - Yong Wang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Inner Mongolia Key Laboratory for Pathogenesis and Diagnosis of Rheumatic and Autoimmune Diseases, Hohhot, China
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2
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Duan H, Gao S, Zhang L, Song L, Zhai J, Deng X. The clinical characteristics and prognosis of patients with SAPHO syndrome--a real-world cohort study. Clin Rheumatol 2024; 43:561-568. [PMID: 37755548 DOI: 10.1007/s10067-023-06782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/22/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES We aimed to analyze the clinical characteristics and outcomes of patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. METHODS The clinical records of 64 patients with SAPHO syndrome were collected, and the treatment and outcomes of 27 patients were followed up. The patients were divided into three groups according to the site of bone lesions: only anterior chest wall (ACW) involvement, only spinal involvement, and bone lesion involvement at both sites. The clinical characteristics and outcomes were compared. The clinical characteristics of the patients with and without peripheral joint involvement were compared. RESULTS Among all patients, 31.25% (20/64) had only ACW involvement, 15.63% (10/64) had only spinal involvement, and 53.12% (34/64) had both ACW and spinal involvement. Peripheral joint involvement was observed in 25.00% (16/64) of the patients. Patients with only spinal involvement were older than those with only ACW involvement (p = 0.006). Patients with both ACW and spinal involvement were older than those with only ACW involvement (p = 0.002) and had a longer diagnosis delay (p = 0.015). Patients with peripheral joint involvement were younger than those without peripheral joint involvement (p = 0.028). During follow-up, 88.89% (24/27) of patients had good outcomes. Twenty-two patients were treated with non-steroidal anti-inflammatory drugs + Iguratimod (IGU), and the outcomes of 90.91% (20/22) improved. CONCLUSIONS A relationship may exist between the sites of bone lesions and clinical characteristics of patients with SAPHO syndrome. The clinical outcomes of these patients may be good, and IGU may be effective in treating SAPHO syndrome. Key Points • This study is the first long-term follow-up on the effectiveness of iguratimod in treating patients with SAPHO. • This study revealed that patients with SAPHO and different bone lesion sites may present with different clinical characteristics.
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Affiliation(s)
- Hongji Duan
- Department of Orthopedic Medicine, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East St, Xicheng District, Beijing, 100035, China
| | - Shuang Gao
- Department of Hematology, Lymphoma Center, Peking University Third Hospital, Beijing, China
| | - Lihua Zhang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Le Song
- Department of Nuclear Medicine, Peking University Third Hospital, Beijing, China
| | - Jiayu Zhai
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - Xiaoli Deng
- Department of Orthopedic Medicine, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East St, Xicheng District, Beijing, 100035, China.
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Lin JY, Bai BX. SAPHO syndrome after COVID-19 vaccination complicated with thyroid function abnormalities: a case report and literature review. Immunol Res 2023; 71:781-784. [PMID: 37079220 PMCID: PMC10117263 DOI: 10.1007/s12026-023-09381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/01/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Jia-Ying Lin
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang, Harbin, 150000, China
| | - Bing-Xue Bai
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang, Harbin, 150000, China.
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Hattori K, Takahashi N, Suzuki M, Kojima T, Imagama S. A case of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome with isolated lesions of the thoracic spine. Mod Rheumatol Case Rep 2023; 7:243-246. [PMID: 35349712 DOI: 10.1093/mrcr/rxac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/01/2022] [Accepted: 03/25/2022] [Indexed: 01/07/2023]
Abstract
We report a case of isolated lesions of the thoracic spine attributed to synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. A 55-year-old woman who suffered from 6 months of back pain had vertebral osteomyelitis on magnetic resonance imaging (MRI). There were no laboratory findings suggestive of infection, malignancy, or autoimmune disease. Radiography, computed tomography (CT), and MRI of the thoracic spine showed mixed lesions of sclerosis and erosion, whereas bone scintigraphy did not show accumulation at any site except the thoracic spine. No lesions in the anterior chest wall or sacroiliac joints were apparent from CT and MRI. No lesions other than at the thoracic spine were observed. As the isolated lesions of the thoracic spine were considered not to have resulted from infection, malignancy, or autoimmune disease, the patient was referred to our department for differential diagnosis. Given that isolated sterile hyperostosis/osteitis among adults is included in the modified diagnostic criteria for SAPHO syndrome, we suspected that the mixed lesions of sclerosis and erosion of the thoracic spine in this case may reflect SAPHO syndrome with chronic non-bacterial osteitis (CNO) of the thoracic spine. Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) was initiated and led to alleviation of her back pain, although the thoracic spine lesions remained on the 6-month MRI. Based on the CNO of the thoracic spine and the rapid response to NSAIDs, the final diagnosis was SAPHO syndrome with isolated lesions of the thoracic spine.
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Affiliation(s)
- Kyosuke Hattori
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Nobunori Takahashi
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Mochihito Suzuki
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toshihisa Kojima
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shiro Imagama
- Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Qiu C, Cheng L, Hou H, Liu T, Xu B, Xiao X, Wang Z, Wang Q. Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome of femoral neoplasm-like onset: a case-based review. J Int Med Res 2021; 49:3000605211065314. [PMID: 34932408 PMCID: PMC8721722 DOI: 10.1177/03000605211065314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is an umbrella term covering a constellation of bone lesions and skin manifestations, but has rarely been clarified in the clinic. We report a 28-year-old woman who had initial onset of SAPHO syndrome with involvement of the femur, and she experienced a tortuous diagnostic course. We also performed a literature review of SAPHO syndrome cases involving the femur and summarize several empirical conclusions by integrating previous findings with our case. Furthermore, we propose our perspective that ailment of the skin caused by infection of pathogens might be the first hit for triggering or perpetuating the activation of the immune system. As a result, musculoskeletal manifestations are probably the second hit by crosstalk of an autoimmune reaction. The skin manifestations preceding bone lesions can be well explained. Current interventions for SAPHO syndrome remain controversial, but drugs aiming at symptom relief could serve as the first preference for treatment. An accurate diagnosis and appropriate treatment can cure patients in a timely manner. Although the pathogenesis of SAPHO syndrome remains to be determined, physicians and surgeons still need to heighten awareness of this entity to avoid invasive procedures, such as frequent biopsies or nonessential ostectomy.
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Affiliation(s)
- Cheng Qiu
- Department of Rheumatology and Autoimmunology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, P. R. China.,Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, P. R. China.,Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, P. R. China
| | - Lin Cheng
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, P. R. China.,Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China
| | - Haodong Hou
- Department of Rheumatology and Autoimmunology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, P. R. China.,Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, P. R. China
| | - Tianyi Liu
- Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, P. R. China
| | - Bohan Xu
- Department of Rheumatology and Autoimmunology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, P. R. China.,Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, P. R. China
| | - Xing Xiao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, P. R. China
| | - Zhankui Wang
- Department of Rheumatology and Autoimmunology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, P. R. China.,Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, P. R. China
| | - Qing Wang
- Department of Rheumatology and Autoimmunology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, 12589Shandong University, Shandong University, Jinan, Shandong, P. R. China.,Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, P. R. China
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Condé K, Guelngar CO, Mohamed A, Adjibaye E, Cissé FA. Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis (SAPHO) Syndrome: Clinical and Therapeutic Aspects. Cureus 2021; 13:e18332. [PMID: 34725595 PMCID: PMC8553276 DOI: 10.7759/cureus.18332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/05/2022] Open
Abstract
Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare entity. It is frequently under-detected. We report the case of SAPHO syndrome in a 38-year-old woman, seen in consultation for pain and swelling of the anterior chest wall affecting the sternoclavicular and sternocostal joints predominantly on the right, and low back pain with an inflammatory appearance with peripheral damage, especially in the legs. We also found in our patient episodes of palmoplantar pustulosis. The diagnosis of SAPHO syndrome was retained in accordance with Kahn's diagnostic criteria, and the osteitis was confirmed by morphological examinations (CT scan, MRI, and bone scintigraphy). The patient was treated with non-steroidal anti-inflammatory drugs and methotrexate with good clinical improvement.
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Affiliation(s)
- Kaba Condé
- Department of Rheumatology, Ignace Deen National Hospital, University of Conakry, Conakry, GIN.,Department of Neurology, Ignace Deen National Hospital, University of Conakry, Conakry, GIN
| | - Carlos Othon Guelngar
- Department of Neurology, Ignace Deen National Hospital, University of Conakry, Conakry, GIN
| | - Awada Mohamed
- Department of Rheumatology, Ignace Deen National Hospital, University of Conakry, Conakry, GIN
| | - Emmanuel Adjibaye
- Department of Infectious Diseases, Reference Hospital, N'Djamena, TCD
| | - Fodé Abass Cissé
- Department of Neurology, Ignace Deen National Hospital, University of Conakry, Conakry, GIN
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Comparative analysis and differentiation between SAPHO syndrome and spondyloarthropathies using whole-spine MRI. Clin Radiol 2021; 76:394.e9-394.e14. [PMID: 33451718 DOI: 10.1016/j.crad.2020.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/11/2020] [Indexed: 11/21/2022]
Abstract
AIM To determine the imaging characteristics of SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome and seronegative spondyloarthropathies (SpAs) on whole-spine magnetic resonance imaging (WS-MRI) and evaluate the role of WS-MRI in the diagnosis and differentiation of the two diseases. MATERIALS AND METHODS Twenty-eight patients with SAPHO and 44 with SpAs were included. All patients were symptomatic and clinically diagnosed with SAPHO or SpAs, and all underwent WS-MRI for comparison of imaging characteristics. RESULTS The mean age of the SAPHO patients was 48.7 ± 12.7 years, while that of the SpA patients was 34.7 ± 12.3 years (p<0.001). WS-MRI showed that the frequency of cervical, thoracic, and lumbar spine involvement was 53.6% versus 52.3%, 75% versus 88.6%, and 60.7% versus 63.6%, respectively (p=0.70, 0.13, and 0.80). The frequency of sacroiliac joint involvement was 7.1% and 100% (p<0.001). Continuous spinal involvement accounted for 50% versus 43.2%, 60.7% versus 84.1%, and 39.3% versus 40.9% in the cervical, thoracic, and lumbar vertebrae, respectively (p=0.03). WS-MRI showed that bone marrow oedema of spinal anterior corner was observed in 50% versus 75% (p=0.03). Vertebral body and posterior attachment involvement accounted for 85.7% versus 93.2% and 14.3% versus 34.1% (p=0.3, 0.06). The frequency of bone erosion in mobile spine was 75% and 36.4%, respectively (p=0.02). The frequency of intervertebral disc, endplate, anterior thoracic wall, and paraspinal soft-tissue swelling was 42.9% versus 18.2%, 53.6% versus 22.7%, 85.7% versus 42.2%, and 50% versus 11.4% (p=0.02, 0.00). CONCLUSIONS Factors differentiating the two groups at WS-MRI were bone marrow oedema of the spinal anterior corner, bone erosion, and swelling of the intervertebral disc, endplate, anterior thoracic wall, and paraspinal soft-tissue.
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Abstract
Acne fulminans (AF) is a rare and severe form of inflammatory acne presenting clinically with an abrupt outburst of painful, hemorrhagic pustules and ulceration, that may or may not be associated with systemic symptoms, such as fever, polyarthritis, and laboratory abnormalities. It typically affects male teenagers with a pre-existing acne. Although the pathogenetic mechanism has not been established yet, a role of genetic, abnormal immunologic response, drugs intake, hormonal imbalance and viral infection, as causal factors, has been identified. AF may occur as a single disease or may be associated with other disorders. Traditionally, AF has been classified, on the basis of the presence of systemic involvement, in "acne fulminans" and acne fulminans "sine fulminans," when no systemic involvement is present. Recently, four clinical variants have been proposed: acne fulminans with systemic symptoms (AF-SS), acne fulminans without systemic symptoms (AF-WOSS), isotretinoin-induced acne fulminans with systemic symptoms (IIAF-SS), isotretinoin-induced acne fulminans without systemic symptoms (IIAF-WOSS). The diagnosis of AF is usually based on clinical history and physical examination. No specific laboratory abnormalities are generally found. In selected cases, biopsy and/or radiologic imaging are helpful for a correct diagnosis. The treatment significantly differs from severe acne according to severity of clinical presentation and possible systemic involvement. Currently, systemic corticosteroids (prednisolone) and retinoids (isotretinoin) represent the first choice of treatment. Dapsone, cyclosporine A, methotrexate, azathioprine, levamisole, and biological agents such as anakinra, infliximab, adalimumab may be considered as alternative therapies in selected cases. Adjunctive topical and physical therapies may also be considered.
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Affiliation(s)
| | | | - Maria R Nasca
- Dermatology Clinic, University of Catania, Catania, Italy
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Gao S, Deng X, Zhang L, Song L. The comparison analysis of clinical and radiological features in SAPHO syndrome. Clin Rheumatol 2020; 40:349-357. [PMID: 32504191 DOI: 10.1007/s10067-020-05187-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/10/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim was to comparatively assess the clinical and imaging features in patients with SAPHO syndrome. METHODS The clinical data, laboratory results, imaging data of forty-six SAPHO patients were reviewed and the SAPHO patients were divided into spinal involvement group and non-spinal involvement group. Fifty patients with ankylosing spondylitis were recruited as control group. The clinical and radiological features of them were analyzed and compared. RESULTS Thirty-four of 46 (73.9%) of all the SAPHO patients had spinal involvement. The lesions exhibited as abnormal hyper-intensity signal in vertebral bodies, vertebral body erosion or collapse, bone marrow edema, endplate inflammation, spondyldiscitis, paravertebral ossification, and facet joint involvement. Compared with patients in non-spinal involvement group, the age at disease onset was older (P = 0.033), the disease duration was longer (P = 0.048), and CRP level was elevated (P = 0.047) in patients in spinal involvement group. Compared with patients with ankylosing spondylitis, SAPHO patients were more likely to have cervical vertebra involvement (P = 0.024), endplate inflammation (P = 0.019), and spondyldiscitis (P = 0.001), but less multiple vertebral body and facet joint involvement (P = 0.002). Patients regularly received DMARDS or biologics treatment had symptoms relieved and lesions turned into chronic stage or better than before. CONCLUSIONS A total of 73.9% of the SAPHO patients had spinal involvement and the involvement could affect any part of the spine. Cervical vertebral involvement, endplate inflammation, and sponlypodiscitis were more common in SAPHO than in patients with ankylosing spondylitis. In SAPHO patients with spinal involvement, the disease duration was longer and the inflammatory reaction was more intensive. DMARDs and biologics may help to prevent the disease progress. KEY POINTS • To the best of our knowledge, this paper is the first one to comparatively study the clinical and radiological features of SAPHO syndrome, especially the characteristics of spinal involvement.
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Affiliation(s)
- Shuang Gao
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - XiaoLi Deng
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China.
| | - Lihua Zhang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Le Song
- Department of Nuclear Medicine, Peking University Third Hospital, Beijing, China
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Liu S, Tang M, Cao Y, Li C. Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: review and update. Ther Adv Musculoskelet Dis 2020; 12:1759720X20912865. [PMID: 32523634 PMCID: PMC7236399 DOI: 10.1177/1759720x20912865] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/23/2020] [Indexed: 12/15/2022] Open
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a spectrum of heterogeneous diseases characterized by osteoarticular and dermatological manifestations. Osteitis and hyperostosis are core clinical manifestations in SAPHO syndrome, typically affecting multiple areas and possibly progressing to irreversible osteoarticular damage. Most patients with SAPHO have cutaneous involvement, mainly manifested as palmoplantar pustulosis and severe acne. Systemic manifestations are uncommon but occasionally reported. Epidemiological studies suggest the annual prevalence of SAPHO syndrome varies from 0.00144 in 100,000 in Japanese individuals to fewer than 1 in 10,000 in White individuals. The precise etiopathogenesis of SAPHO remains unclear, but it is generally considered an autoinflammatory syndrome that may be related to various etiologies, such as immune dysfunction, infection and genetic predisposition. Owing to the relapsing-remitting disease course, the goal of management is to improve clinical symptoms and prevent disease progression. Various treatments, including nonsteroidal anti-inflammatory drugs, conventional disease-modifying antirheumatic drugs, bisphosphonates, biologics, and antibiotics, are promising options for alleviating the disease.
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Affiliation(s)
- Shuang Liu
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingwei Tang
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yihan Cao
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.9 Dong Dan San Tiao, Beijing 100730, China
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Li Y, Liu G, Zhao Y, Luo Y, Lu T. SAPHO syndrome with pathological fractures of vertebral bodies: a case report. BMC Musculoskelet Disord 2019; 20:27. [PMID: 30654792 PMCID: PMC6337767 DOI: 10.1186/s12891-019-2410-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 01/08/2019] [Indexed: 12/30/2022] Open
Abstract
Background It’s difficult to diagnose and treat synovitis-acne-pustulosis-hyperostosis-osteomyelitis (SAPHO) syndrome due to its rare and unknown pathogenesis. There is no effective treatment for SAPHO syndrome and the consequences of empirical treatment are unpredictable. This study reports a case of a young female diagnosed as SAPHO syndrome with pathological fractures of vertebral bodies. Case presentation A 29-year-old female complained of the right sternoclavicular joint and back pain accompanied limited activities and cutaneous lesions. Laboratory assays revealed abnormal inflammatory factors. Multiple imaging studies illustrated bone lesions and pathological fractures of vertebral bodies. A diagnosis of SAPHO syndrome was made. The patient was treated with Compound Troxerutin and Poreine Cerebroside Injection, non-steroidal anti-inflammatory drugs (NSAIDs), bisphosphonates, corticosteroids and the thoracolumbar brace. The patient was followed up for 6 months and showed improved results. Conclusions The case supports that multiple image inspections and laboratory tests contribute to diagnose SAPHO syndrome, and combination therapies of Compound Troxerutin and Poreine Cerebroside Injection, NSAIDs, bisphosphonates, corticosteroids and the thoracolumbar brace in the treatment of SAPHO syndrome with pathological fractures of vertebral bodies are crucial to regain health.
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Affiliation(s)
- Yalong Li
- Department of Orthopedics, the Second Hospital of Jilin University, Changchun, Jilin, 130041, People's Republic of China.,Jilin provincial Changbai mountain medicine anti-tumor engineering center, Jilin, People's Republic of China
| | - Guomin Liu
- Department of Orthopedics, the Second Hospital of Jilin University, Changchun, Jilin, 130041, People's Republic of China.,Jilin provincial Changbai mountain medicine anti-tumor engineering center, Jilin, People's Republic of China
| | - Yian Zhao
- Department of Stomatology, the Second Hospital of Jilin University, Changchun, Jilin, 130041, People's Republic of China.,Jilin provincial Changbai mountain medicine anti-tumor engineering center, Jilin, People's Republic of China
| | - Yungang Luo
- Department of Stomatology, the Second Hospital of Jilin University, Changchun, Jilin, 130041, People's Republic of China. .,Jilin provincial Changbai mountain medicine anti-tumor engineering center, Jilin, People's Republic of China.
| | - Tiancheng Lu
- Life Sciences College, Jilin Agricultural University, Changchun, Jilin, 130118, People's Republic of China. .,Jilin provincial Changbai mountain medicine anti-tumor engineering center, Jilin, People's Republic of China.
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Affiliation(s)
- Ufuk İlgen
- Department of Rheumatology, Trakya University School of Medicine, Edirne, Turkey
| | - Sezin Turan
- Department of Rheumatology, Trakya University School of Medicine, Edirne, Turkey
| | - Hakan Emmungil
- Department of Rheumatology, Trakya University School of Medicine, Edirne, Turkey
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Asano T, Furuya MY, Fujita Y, Matsuoka N, Sato S, Kobayashi H, Watanabe H, Honda A, Migita K. Diagnostic value of ultrasonography in synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome: A case report. Medicine (Baltimore) 2018; 97:e12725. [PMID: 30313072 PMCID: PMC6203473 DOI: 10.1097/md.0000000000012725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is a rare condition that affects the skin, bones, and joints. Diagnosis of SAPHO syndrome is established based on clinical manifestations and imaging features on radiography or magnetic resonance imaging. PATIENT CONCERNS We report a 44-year-old male with a 20-year history of pustulosis who presented with pain in the lower extremities. Plain radiography demonstrated hyperostosis with subperiosteal erosions in the right tibia. Magnetic resonance imaging and computed tomography showed inflammatory accumulation, whereas musculoskeletal ultrasonography clearly depicted a periosteal reaction, osteitis, and enthesitis with abnormal blood flow in the surface of the right tibia. DIAGNOSES A diagnosis of SAPHO syndrome was made. INTERVENTIONS The patient was treated with combination therapy comprising prednisolone, methotrexate, and infliximab, which resulted in clinical improvement. OUTCOMES The elevated levels of C-reactive protein and matrix metalloproteinase-3 normalized, and the abnormal ultrasonographic findings disappeared. LESSONS The present case report demonstrates that multiple imaging modalities are important for the definitive diagnosis of SAPHO syndrome. Ultrasonography might be a useful tool for evaluating local musculoskeletal inflammation in patients with SAPHO syndrome.
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Affiliation(s)
| | | | | | | | | | | | | | - Aki Honda
- Department of Dermatology, School of Medicine, Fukushima Medical University, Fukushima, Japan
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14
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Smereczyński A, Kołaczyk K, Bernatowicz E. Chest wall - underappreciated structure in sonography. Part II: Non-cancerous lesions. J Ultrason 2017; 17:275-280. [PMID: 29375903 PMCID: PMC5769668 DOI: 10.15557/jou.2017.0040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 12/04/2022] Open
Abstract
The chest wall is a vast and complex structure, hence the wide range of pathological conditions that may affect it. The aim of this publication is to discuss the usefulness of ultrasound for the diagnosis of benign lesions involving the thoracic wall. The most commonly encountered conditions include sternal and costal injuries and thoracic lymphadenopathy. Ultrasound is very efficient in identifying the etiology of pain experienced in the anterior chest wall following CPR interventions. Both available literature and the authors' own experience prompt us to propose ultrasound evaluation as the first step in the diagnostic workup of chest trauma, as it permits far superior visualization of the examined structures compared with conventional radiography. Sonographic evaluation allows correct diagnosis in the case of various costal and chondral defects suspicious for cancer. It also facilitates diagnosis of such conditions as degenerative lesions, subluxation of sternoclavicular joints (SCJs) and inflammatory lesions of various etiology and location. US may be used as the diagnostic modality of choice in conditions following thoracoscopy or thoracotomy. It may also visualize the fairly common sternal wound infection, including bone inflammation. Slipping rib syndrome, relatively little known among clinicians, has also been discussed in the study. A whole gamut of benign lesions of thoracic soft tissues, such as enlarged lymph nodes, torn muscles, hematomas, abscesses, fissures, scars or foreign bodies, are all easily identified on ultrasound, just like in other superficially located organs.
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Affiliation(s)
- Andrzej Smereczyński
- Self-education Sonography Group, Genetics Division, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Kołaczyk
- Self-education Sonography Group, Genetics Division, Pomeranian Medical University, Szczecin, Poland
| | - Elżbieta Bernatowicz
- Self-education Sonography Group, Genetics Division, Pomeranian Medical University, Szczecin, Poland
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